ABSTRACT
BACKGROUND: In autosomal dominant polycystic kidney disease (ADPKD), cyst development and enlargement lead to ESKD. Macrophage recruitment and interstitial inflammation promote cyst growth. TWEAK is a TNF superfamily (TNFSF) cytokine that regulates inflammatory responses, cell proliferation, and cell death, and its receptor Fn14 (TNFRSF12a) is expressed in macrophage and nephron epithelia. METHODS: To evaluate the role of the TWEAK signaling pathway in cystic disease, we evaluated Fn14 expression in human and in an orthologous murine model of ADPKD. We also explored the cystic response to TWEAK signaling pathway activation and inhibition by peritoneal injection. RESULTS: Meta-analysis of published animal-model data of cystic disease reveals mRNA upregulation of several components of the TWEAK signaling pathway. We also observed that TWEAK and Fn14 were overexpressed in mouse ADPKD kidney cysts, and TWEAK was significantly high in urine and cystic fluid from patients with ADPKD. TWEAK administration induced cystogenesis and increased cystic growth, worsening the phenotype in a murine ADPKD model. Anti-TWEAK antibodies significantly slowed the progression of ADPKD, preserved renal function, and improved survival. Furthermore, the anti-TWEAK cystogenesis reduction is related to decreased cell proliferation-related MAPK signaling, decreased NF-κB pathway activation, a slight reduction of fibrosis and apoptosis, and an indirect decrease in macrophage recruitment. CONCLUSIONS: This study identifies the TWEAK signaling pathway as a new disease mechanism involved in cystogenesis and cystic growth and may lead to a new therapeutic approach in ADPKD.
Subject(s)
Cytokine TWEAK/metabolism , Polycystic Kidney, Autosomal Dominant/metabolism , Polycystic Kidney, Autosomal Dominant/pathology , TWEAK Receptor/metabolism , Adult , Animals , Antibodies, Neutralizing/pharmacology , Apoptosis , Cell Proliferation/drug effects , Cysts/metabolism , Cysts/pathology , Cytokine TWEAK/antagonists & inhibitors , Cytokine TWEAK/genetics , Cytokine TWEAK/pharmacology , Disease Models, Animal , Disease Progression , Female , Fibrosis , Gene Expression , Humans , Macrophage Activation/drug effects , Macrophages , Male , Mice , Middle Aged , NF-kappa B/metabolism , Polycystic Kidney, Autosomal Dominant/physiopathology , Signal Transduction , TWEAK Receptor/geneticsABSTRACT
Affective disorders promote poorer outcomes in hemodialysis patients. According to the presence or not of depression/anxiety in these patients, aims were to analyze differences in sociodemographic, clinical and/or psychological factors and to identify predictors. One hundred eighty-six hemodialysis patients were classified based on their depression/anxiety status. Basal characteristics showed differences between groups where mainly male sex (Depression: OR 0.2; Anxiety: OR 0.3) albumin (Depression: OR 0.1; Anxiety: OR 0.2) and calcium levels (Depression: OR 0.5; Anxiety: OR 0.4), impaired quality of life (Depression: OR 1.4; Anxiety: OR 1.2) and psychological inflexibility (Depression: OR 1.3; Anxiety: OR 1.2) were associated (all p < 0.01) to these mental conditions. Multivariate models showed that worse quality of life (OR 1.3; p < 0.001) predicted depression while marital status (with a partner; OR 0.3; p = 0.025) and albumin levels (OR 0.1; p = 0.027) were protective factors. Depression represented a risk factor for anxiety (OR 1.2; p = 0.001), although calcium levels (OR 0.5; p = 0.039) would protect this state. Interestingly, psychological inflexibility predicted both disorders (Depression: OR 1.2, p < 0.001 and Anxiety: OR 1.1; p = 0.002). Results highlight the relevance of well-trained multidisciplinary hemodialysis units to control the influence of these factors on the presence of depression/anxiety, and thus, their impact on the patients' outcomes.
Subject(s)
Depression , Quality of Life , Anxiety/epidemiology , Anxiety Disorders , Cross-Sectional Studies , Depression/epidemiology , Humans , Male , Renal DialysisABSTRACT
Programmed cell senescence during embryo development is a recently described process that opens a new perspective to understand the senescence response and that adds a new player whose contribution to development needs to be addressed. Identifying developmental syndromes with a root in deregulated programmed cell senescence will undoubtedly reinforce our view of senescence and could provide a new angle to confront disease. One of the structures that was initially reported to undergo cellular senescence is the mesonephros. During E12.5-E14.5, before regression, mesonephric tubules are positive for the most widely used marker of cell senescence, SAßG, and negative for proliferation marker, Ki67, in a p21Cip1-dependent manner. PKD2 is one of the genes defective in autosomal dominant polycystic kidney disease (ADPKD). Inherited mutations in this gene result in cyst formation in adults after a secondary hit. Polycystin-2 (PC2) protein, the product of PKD2 gene expression, inhibits cell cycle progression by inducing p21Cip1, whereas mutated PKD2 results in increased proliferation and defective differentiation of kidney epithelial cells. Here, we addressed the possibility of defective programmed cell senescence as a consequence of Pkd2 deletion in mice. We analyzed embryos for the expression of the senescence marker SAßG, for the proliferative status of mesonephric tubule cells, and for the expression of p21Cip1, without identifying any noticeable deregulation of cell senescence. Our results exclude defective programmed cell senescence upon Pkd2 ablation as an initial event in ADPKD.
